Provider Demographics
NPI:1649333725
Name:MOHEB, TINA (DMD)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:
Last Name:MOHEB
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1630
Mailing Address - Country:US
Mailing Address - Phone:973-857-7799
Mailing Address - Fax:
Practice Address - Street 1:685 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-1630
Practice Address - Country:US
Practice Address - Phone:973-857-7799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI020655001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice